Provider Demographics
NPI:1336561430
Name:BENNETT, SHELBY (LISW)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2010
Mailing Address - Country:US
Mailing Address - Phone:319-596-5910
Mailing Address - Fax:319-352-1993
Practice Address - Street 1:2022 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2010
Practice Address - Country:US
Practice Address - Phone:319-596-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical